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This presentation shows how to remove unnecessary Healthcare Costs using Quality, Safety, and High Reliability Tools.
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Strategies for …
Removing Millions in Unnecessary Costs
John Byrnes, MD!!Clinical Associate Professor MSU, College of Human Medicine !!Founder & Sr. Partner!Byrnes Healthcare Group
What’s Going On?
Many Errors Go Unrecognized❖ Preventative Care!
❖ 26 of 29 nodes positive!❖ 2 lesions in the liver!
❖ Illeus diagnosed by nursing ☺!❖ TPN recommended by nursing ☺!❖ Couldn’t read doc writing!❖ Couldn’t read nursing notes!❖ Couldn’t read signatures!❖ White boards inconsistent!❖ Fuzz balls and ventilation screens!❖ No standard orders!❖ No care pathways!❖ Communication btwn caregivers poor!❖ Who’s the doc?!❖ Who’s the nurse today?
❖ Fractionated doc coverage!❖ 3 different nephrologists in 3 days!
❖ Fractionated nursing coverage!❖ Multiple reassignments during shift!
❖ 3 RN + 1 LPN !❖ 30 bed oncology unit on weekend!❖ JB helped put in NG, moving help!
❖ Calls for pain meds!❖ Often not answered for 30-45 min.!❖ Restarted PCA pump!
❖ Lasix drip – 7 hours later!❖ TPN – 24 hours later!❖ Pressure ulcers/skin breakdown!
❖ Day #4!❖ SCDs off for unknown period!
❖ Day #3 in ICU, assignment changed at 11 am!
❖ Two patient ID’s - infrequent
My Mother My Grandfather My Father
By our community, our friends, our families, and our patients
“Our obligation, to our patients, is one of the most sacred trusts given to us….”
Findings supported by Classen and Leape. PAE: Preventable Adverse Events
440,000 Deaths per Year“PAEs account for “roughly
one-sixth of all deaths that
occur in the U.S. each year.”
Sources:))James,)J,)“New,)Evidence6Based)Estimate)
of)Patient)Harms)Associated)with)Hospital)Care,”)
Journal(of(Patient(Safety,)September)2013.H
H
–The Advisory Board Company, Sept. 24, 2013
“Medical Errors May Be the Country’s Third Leading Cause of Death”
Answer: High Reliability Organizations
A Culture of SAFETY
C-Suite Leaders:
You Hold the Key
“The culture of a company, is the behavior of its leaders … You change the
culture of a company by changing the behavior of its leaders.”!
!Dick Brown
Safety Culture
Ignites Hospital TurnaroundNo harm events in over 835 days!!Top 100 Hospital last three years in a row!!Before – mired in controversy and almost closed by the community
ELIMINATE DEADLY MEDICAL ERRORS
Using 10 High Reliability Tools
PROCESS IMPROVEMENTLean, Toyota, Six Sigma
Lean QI Initiative - CV Service Line
Cardiac Cath Lab
Savings = $6.7 million!!! On time starts!! Throughput & room turnover!! Open and unused supplies ($3M)!! Preference card variation!! Non indicated add-on procedures!! Number of stents!! Appropriateness
Medication Administration Process
125 Process Steps Before < 25 Steps After
Disclaimer, AKA The Fine Print
All calculations performed by the Director of Decision Support, assorted financial analysts, and verified by a Chief Financial Officer.!
!No calculations performed by this doctor person.
$68,000,000
Clinical QI Can Remove $MILLIONS in Unnecessary Costs
IMPACT at One Hospital
Revenue!$32 Million
Savings!$36 Million
Total = $68 Million Hospital Margin $74 Million
Study on select conditions through November, 2008; Pediatrics, ICUs, Trauma not included.
$32 Million Revenue Impact
❖ ABC Health P4P Plan $ 4,274,211!
❖ XYZ P4P Plan 19,663,131!
❖ CMS Market Basket Update* 8,107,477!
❖ TOTAL $ 32,044,819
*Now VBP + >50% upside
Eliminating ComplicationsSaved $36 M
Study on select conditions through November, 2008; Pediatrics, ICUs, Trauma not included.
Average Costs of Common Complications
❖ Decubitus Ulcer! ! ! ! $28,272!
❖ Post-op Deep Wound Infection! $27,814!
❖ Clostridium Difficile Colitis!! $25,401!
❖ Sepsis! ! ! ! ! $23,451!
❖ Reopen Surgical Site! ! ! $19,442!
❖ Venous Thrombosis! ! ! $15,976!
❖ Pulmonary Embolism! ! ! $16,331!
❖ UTI!! ! ! ! ! $ 9,637Richard Fuller, Elizabeth McCullough, Mona Bao, Richard Averill, Estimating the Costs of
Potentially Preventable Hospital Acquired Complications, Health Care Finance Review, Summer, 2009, 30:17-‐‑32
DVT $180,000
ARF $820,000
Abcess $75,000
Int. Obstruction $545,000
Acc. Op. Laceration $203,000
Resp. Failure $971,000
Wound Infection $260,000
TOTAL $3,054,000
Physician Leaders Save Money
A Quarter Time Physician Leader!
• Episode of Care: Colon Surgery!!
• 7 Preventable Complications
A small group of physician leaders can remove $ Millions in unnecessary costs
Hospital Acquired Infection RatesAdult Critical Care - 2008 to 2009
MRSA, Acinetobacter, Pseud/Sten/Serratia, and C. diff Infections
0
5
10
15
20
Jan 08 - Dec 08 Jan 09 - Dec 09
Infection Rate per 1000 Pt. Days
42% Decrease 126 Fewer Patients
126 x $14,000 = $1.8 M
Hospital Acquired Infection Rates - 2008 to 2009 A Children’s Hospital
HDVCH HA MRSA, VRE, ESBL/Amp C, C. diff, and RSV
0
0.5
1
1.5
2
Jan 08 - Dec 08 Jan 09 - Dec 09
Infection Rate per 1000 Pt. Days
46% Decrease 40 Fewer Patients
Combined Results!166 x $14,000 = $2.3 M
Preventing Readmissions - Total Cost of Care
Hysterectomy! ! ! ! 6.7% to 3.8%! ! ! ! $ 42,000!
Hysterectomy CA! ! ! 4.5% to 10.6%! ! ! ! $ 153,000!
Lumbar fusion !! ! 5.4% to 4.2%! ! ! ! $ 830,000!
Peds Chemo ! ! ! 9.9% to 8.3%! ! ! ! $ 685,000!
AMI ! ! ! 12.7% to 8.3%! ! ! ! $2,085,000!
PCI ! ! ! 8.2% to 5.3%! ! ! ! $ 618,000!
EP Ablation !! ! 4.1% to 3.3%! ! ! ! $ 56,000! !
Cholecystectomy !! ! 6.9% to 3.9%! ! ! ! $ 50,000!
TOTAL!! ! ! ! ! ! ! ! ! ! ! ! $4,519,000
Clinical QI Can Remove $MILLIONS in Unnecessary Costs
Prevent Readmissions
Majority of Readmissions:!1. Didn’t fill prescriptions!2. Didn’t get timely follow-up!3. Care coordination
Opportunity Analysis - 10 Years LaterClinical QI Can Remove $MILLIONS in Unnecessary Costs
$45,000,000 Remaining Opportunity
–Joseph J. Fifer, FHFMA, CPA President & CEO, HFMA
“Quality and Safety (and their related process improvements) is the next frontier of cost
management.”
Opportunity Analysis
How Much Potential Savings (Waste)?❖ Small Multi-Hospital System!❖ Observed to Expected Complication Rate!❖ >2,000 Complications!❖ >$60,000,000
Clinical QI Can Remove $MILLIONS in Unnecessary Costs
3 High-Impact Tools
Save LivesSave $!Make $
SAFETY - High-Reliability
Clinical QI Performance Improvement
$68,000,000
$60,000,000
$45,000,000
$4,500,000
$66,800,000
$3,054,000
$2,300,000
$6,700,000
Summary of Savings:
$ MillionsOne hospital: cost + additional revenue!Small hospital system - complications!Opportunity after 10 years - one hospital!Readmissions prevented!Malpractice claim impact of HRO program!Colon Surgery - 7 Complications!Hospital Acquired Infections - one hospital!Cath Lab!TOTAL $256,354,000
Everyday, Remember Why You’re There …They Entrust Us With Their Lives, Let’s Not Let Them Down !
Improving Quality & Safety Together
Resource Page:
John Byrnes MD!Trainer, Consultant & Keynote Speaker!!Founder, Sr. Partner!Byrnes Healthcare Group!!Phone [email protected]!www.johnbyrnesmd.org
